Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-10-2011 | Original Article

The short-term functional and radiological outcome of patients treated with the Synthes proximal femoral nail antirotation (PFNA) for unstable proximal femoral fractures

Authors: P. M. Guyver, M. J. H. McCarthy, N. P. M. Jain, J. Keenan

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 7/2011

Abstract

Between April 2006 and December 2007, 74 patients with unstable proximal femoral fractures were treated with the proximal femoral nail antirotation (PFNA). Follow-up to union was achieved for 55 nails in 52 patients. Fifteen patients (20% of the total) died during the initial 4-month follow-up period. Clinical 4-month follow-up was completed in 83% (45 of 54 patients). Radiological follow-up to union was completed in 96% (52 of 54 patients). The mean age was 78.5 years with 10 males and 44 females. The mean tip apex distance was 22 mm. The mean migration in tip apex distance was 0.8 mm, and no blade cut out was seen. In six patients, the distal locking bolts migrated or became loose. Almost one-third of patients had trochanteric tenderness. The mean visual analogue score (VAS) at follow-up was 3/10. The mobility and social function scores were significantly reduced at follow-up compared to preoperative status (P = 0.001). All domains of short-form 36 (SF36) were low compared to normative data.

Lorich DG, Geller DS, Hielson JH (2004) Osteoporotic pertrochanteric fractures: management and current controversies. J Bone Joint Surg Am 86:398–410

BOA (2007) The care of fragility fracture patients. British Orthopaedic Association Publication, UK

Mahomed N, Harrington I, Kellam J, Maistrelli G, Hearn T, Vroemen J (1994) Biomechanical analysis of the gamma nail and sliding hip screw. Clin Orthop Relat Res 304:280–288PubMed

Robinson CM, Houshian S, Khan LAK (2005) Trochanteric-entry long cephalomedullary nailing of subtrochanteric fractures caused by low-energy trauma. J Bone Joint Surg Am 87:2217–2226PubMedCrossRef

Sadowski C, Lubbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P (2002) Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intra-medullary nail or a 95° screw-plate. J Bone Joint Surg Am 84:372–381PubMed

Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF (2005) Unstable pertrochanteric femoral fractures. J Orthop Trauma 19:63–66PubMedCrossRef

Kummer FJ, Olsson O, Pearlman CA, Ceder L, Larsson S, Koval KJ (1998) Intra-medullary versus extra-medullary fixation of subtrochanteric fractures- a biomechanical study. Acta Ortho Scand 69:580–584CrossRef

Committee for Coding, Classification of the Orthopaedic Trauma Association (1996) Fracture and dislocation compendium. J Orthop Trauma 10(Suppl. 1):31–32

Gotfried Y (2004) The lateral trochanteric wall—a key element in the reconstruction of unstable pertrochanteric hip fractures. Clin Orth Relat Res 425:82–86CrossRef

10.

Adams CI, Robinson CM, Court-Brown CM, McQueen MM (2001) Prospective randomized controlled trial of intra-medullary nail versus dynamic hip screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma 15:394–400PubMedCrossRef

11.

Handoll H, Parker M (2006) Hip fracture. Clinical evidence 15. BMJ Publishing, UK

12.

Jones HW, Johnston P, Parker M (2006) Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures. Int Orthop 30:69–78PubMedCrossRef

13.

Anglen JO, Weinstein JN (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American board of orthopaedic surgery database. J Bone Joint Surg Am 90:700–707PubMedCrossRef

14.

Bail HJ, Schaser KD, Stockle U, Haas NP (2005) First experience with a new principle of fixation: preliminary results from the clinical application of the proximal femoral nail-A (PFNA). Presentation at Osteosynthese International, Hamburg

15.

Haidukewych GJ, Israel TA, Berry DJ (2001) Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am 83:643–650PubMed

16.

Parker MJ, Handoll HH (2006) Intra-medullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev 3:CD004961PubMed

17.

Simmermacher RKJ, Bosch AM, Van der Werken C (1999) The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of proximal femoral fractures. Injury 30:327–332PubMedCrossRef

18.

Van der Werken C, Simmermacher RJK (2005) PFNA; a better implant for the treatment of unstable pertrochanteric fractures?. Presentation at EFFORT, Lisbon

19.

Hockertz TJ (2005) PFNA—Does this new implant for per/subtrochanteric femoral fractures offer any advantages? Synthes Trauma Facts.

20.

PFNA Surgical Technique (2004) Synthes Inc, Switzerland

21.

Domingo LJ, Cecilia D, Herrera A, Resines C (2001) Trochanteric fractures treated with a proximal femoral nail. Int Orthop 25(5):298–301PubMedCrossRef

22.

Friedl W, Clausen J (2001) Experimental examination for optimized stabilisation of trochanteric femur fractures, intra- or extramedullary implant localisation and influence of femur neck component profile on cut-out risk. Chirurg 72(11):1344–1352PubMedCrossRef

23.

Windolf J, Hollander DA, Hakimi M, Linhartet W (2005) Pitfalls and complications in the use of the proximal femoral nail. Langenbecks Arch Surg 390(1):59–65PubMedCrossRef

24.

Somers MB, Roth C, Hall H, Kam BCC, Ehmke LW, Krieg JC, Madey SM, Bottlang M (2004) A laboratory model to evaluate cut out resistance of implants for pertrochanteric fracture fixation. J Orthop Trauma 18:361–368CrossRef

25.

Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N (2006) Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury 37:984–989PubMedCrossRef

26.

Amin A, Mahaluxmivala J, Ramkumar U, Hill R (2007) Failure of the spiral blade and intramedullary nail in the treatment of ipsilateral femoral neck and shaft fractures. Injury Extra 38:84–87CrossRef

27.

Datir SP, Bedi GS, Curwen CH (2004) Unreamed femoral nail with spiral blade in subtrochanteric fractures: experience of 55 cases. Injury 35:191–195PubMedCrossRef

28.

Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N (2009) The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury 40:428–432PubMedCrossRef

29.

Takigami I, Matsumoto K, Ohara A, Yamanaka K, Naganawa T, Ohashi M, Date K, Shimizu K (2008) Treatment of trochanteric fractures with the PFNA (proximal femoral nail antirotation) nail system a report of early results. Bull NYU Hosp Jt Dis 66(4):276–279PubMed

30.

Simmermacher RK, Ljungqvist J, Bail H, Hockertz T, Vochteloo AJ, Ochs U, Werken C (2008) The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study. Injury 39:932–939PubMedCrossRef

31.

Brunner A, Jockel JA, Babst R (2008) The PFNA proximal femur nail in treatment of unstable proximal femur fractures–3 cases of postoperative perforation of the helical blade into the hip joint. J Orthop Trauma 22(10):731–736PubMedCrossRef

32.

Wijeratna MD, Patel AD (2007) The proximal femoral nail antirotation (PFNA)—113 patients, the Norwich experience. Poster Presentation, British Trauma Society, Nottingham

33.

Larsson S, Friberg S, Hansson L (1990) Trochanteric fractures—influence of reduction and implant position on impaction and complications. Clin Orthop Relat Res 259:130–139PubMed

34.

Jensen JS, Bagger J (1982) Long-term social prognosis after hip fractures. Acta Orthop Scand 53:97–101PubMedCrossRef

35.

Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 75:797–798PubMed

36.

Ware JE, Kosinski M, Bjorner JB, Turner-Bowker DM et al (2007) User’s manual for the SF-36v2 health survey. Quality metric incorporated

37.

Corrales LA, Morshed S, Bhandari M, Miclau T (2008) Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am 90:1862–1868PubMedCrossRef

38.

Johnson LJ, Cope MR, Shahrokhi S, Tamblyn P (2008) Measuring tip-apex distance using a picture archiving and communication system (PACS). Injury 39:786–790PubMedCrossRef

39.

Baumgaertner MR, Solberg BD (1997) Awareness of tip-apex distance reduces the failure of fixation of trochanteric fractures of the hip. J Bone Joint Surg Br 79:969–971PubMedCrossRef

40.

Borjan A, Oldenburg G, Speitling A (2002) Positioning of the lag screw—literature summary. Stryker trauma report

41.

Wu CC, Shih CH, Lee MY, Tai CL (1996) Biomechanical analysis of location of lag screw of a dynamic hip screw in treatment of unstable intertrochanteric fracture. J Trauma 41:699–702PubMedCrossRef

42.

Gardner MJ, Bhandari M, Lawrence BD, Helfet DL, Lorich DG (2005) Treatment of intertrochanteric hip fractures with the AO trochanteric fixation nail. Orthopaedics 28:117–122

43.

Gardner MJ, Briggs SM, Kopjar B, Helfet DL, Lorich DG (2007) Radiographic outcomes of intertrochanteric hip fractures treated with the trochanteric fixation nail. Injury 38:1189–1196PubMedCrossRef

44.

Ekstrom W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts KA (2007) Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. J Orthop Trauma 21(1):18–25PubMedCrossRef

45.

Peyser A, Weil YA, Brocke L, Sela Y, Mosheiff R, Mattan Y, Manor O, Liebergall M (2007) A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip. J Bone Joint Surg Br 89:1210–1217PubMedCrossRef

46.

Jaglal S, Lakhani Z, Schatzker J (2000) Reliability, validity, and responsiveness of the lower extremity measure for patients with a hip fracture. J Bone Joint Surg Am 82-A(7):955–962PubMed

47.

Ongkiehong BF, Leeman R (2007) Proximal femoral nail failure in a subtrochanteric fracture: the importance of fracture to distal locking screw distance. Injury Extra 38:445–450CrossRef

Title: The short-term functional and radiological outcome of patients treated with the Synthes proximal femoral nail antirotation (PFNA) for unstable proximal femoral fractures
Authors: P. M. Guyver
M. J. H. McCarthy
N. P. M. Jain
J. Keenan
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 7/2011
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-010-0745-y

At a glance: The STEP trials

Springer Medicine

The short-term functional and radiological outcome of patients treated with the Synthes proximal femoral nail antirotation (PFNA) for unstable proximal femoral fractures

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2011

Tuberculosis of knee mimicking synovial malignancy: a diagnostic dilemma

Aggressive and rapid progression of idiopathic bilateral avascular necrosis of femoral head in an old woman suffering from osteoporosis: A case report and review of the literature

The infected knee prosthesis

Open reduction internal fixation of midshaft clavicle fractures augmented with autogenous bone graft versus bioresorbable calcium phosphate: a comparative study

Repeat offenders: non-attenders! A review of elective orthopaedic clinics

Subtrochanteric femoral fractures: a comparative study of the long proximal femoral nail and the long trochanteric fixation nail